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Saving the Lives of Moms

A Tanzanian woman after receiving a spinal anesthetic in advance of a $450 surgery to repair a fistula — and her life.Credit
Béatrice de Géa for The New York Times

THIS is a Mother’s Day tribute to a mighty woman and to the doctor who gave her back her life — and also a celebration of a grand new women’s hospital that you as readers helped to build.

The woman is Mahabouba Mohammed, an Ethiopian who was raped at about age 13. She gave birth alone: after many days of labor, the baby was stillborn and she suffered an obstetric fistula.

A fistula is just about the worst fate that can happen to a woman or girl. It’s a childbirth injury that causes her to leak urine or feces continuously through her vagina. In Mahabouba’s case, she also suffered nerve damage in both legs so that she couldn’t walk.

More than two million women and girls have fistulas worldwide. They are the lepers of the 21st century, among the most voiceless and shunned people on earth. Fistulas were once also common in America (a fistula hospital was once located in Manhattan where the Waldorf-Astoria Hotel is now), but today they normally afflict only people in poor countries of Africa and Asia.

When the hyenas came, Mahabouba used a stick to fend them off. The next morning she set off crawling to get to an American missionary who lived more than 30 miles away. The missionary took her to the Addis Ababa Fistula Hospital, where she met Steven Arrowsmith, an American urologist from Grand Rapids, Mich.

Arrowsmith, now 54, has devoted his life to helping women and girls with fistulas, and he has almost certainly repaired more fistulas than any other American doctor. But Mahabouba’s case was unusually complicated — much of her tissue had rotted away — and she was in a deep depression.

“It was painful to be within three feet of her, because she was so miserable,” Arrowsmith recalled. She was also illiterate and did not understand the main Ethiopian language or the ways of cities.

He laughs now as he recalls the time his wife, Jan, a family physician, took Mahabouba to a prosthesis shop to get a leg brace so she could try walking again. Everybody else in the store had lost a leg or two from land mines, and Mahabouba grew panicky. Fearing that she was about to have her legs sawed off, she tried to flee.

In the end Arrowsmith performed a $450 surgery on Mahabouba to repair her fistula. While she recovered, she began to help out in the ward. Smart and capable, she was given more responsibilities, and by the time I met her in 2003, she was on the hospital’s nursing staff. She’s a wonderful example of how such women can be turned from squandered assets into productive resources.

Photo

Nicholas KristofCredit
Damon Winter/The New York Times

Mahabouba has become very close to the Arrowsmiths, calling them Mommy and Daddy. When she won an apartment in a lottery in the Ethiopian capital, she was thrilled because, as she told the Arrowsmiths, “Now that I have a place, I can take care of you when you’re old.”

Then there was the Liberian woman who, after her fistula was repaired, named a grandchild “Doctor Steve.” In Niger, the women have affectionately named Dr. Arrowsmith “Chief of Urine” — and all this makes him think that he has the world’s best job.

“People in America can’t believe I left urology to do this, but this is about changing lives,” which is better than “listening to men tell me about the quality of their erections,” he said. “I’ve had my family held at gunpoint, I’ve had malaria, I’ve had a serious exposure to H.I.V., I’ve been separated from family, and I’ve spent about a million hours crammed into coach class on airlines, but it’s worth it. I’d much rather live a meaningful life than a comfortable one.”

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Left untreated, women and girls with fistulas become pariahs. Their husbands divorce them, and they are moved to a hut at the edge of the village. They lie there in pools of their waste, feeling deeply ashamed, trying to avoid food and water because of the shame of incontinence, and eventually they die of an infection or simple starvation.

For years, Dr. Arrowsmith has been dreaming — along with Dr. Lewis Wall, a fistula expert at Washington University School of Medicine in St. Louis — of establishing a fistula hospital in West Africa. After I wrote about their organization, the Worldwide Fistula Fund, a couple of years ago, Times readers responded with an outpouring of support — some $500,000.

This is what your contributions achieved: The hospital recently opened in Danja, Niger. More than 60 women with fistulas were waiting at the ribbon-cutting, and a surgeon from the nearby country of Burkina Faso is working through the backlog.

The hospital has also started an outreach program to provide prenatal care, family planning and other help for maternal and child health. The aim is to save lives as well as prevent fistulas.

NOW Dr. Arrowsmith and Dr. Wall are trying to raise $500,000 in annual operating costs so that the hospital can perform up to 1,000 fistula repairs a year.

“It’s a very small amount of money for the difference it can make in somebody’s life,” Dr. Wall said. “The problem is that an amount like that, less than the cost of an iPad in the States, is too much for the average African who suffers from the problem.”

This Mother’s Day, we’ll spend $18 billion on flowers, dinners and spa treatments — all of which is merited. But it is also an occasion to celebrate much more modest gifts that have created a hospital with transformational power.

You see the power of such a gift when you watch Mahabouba attend to frightened, ashamed teenage girls with fistulas. And Mahabouba will soon spread her wings further: the new fistula hospital plans to bring her to Niger so that she can help train the nursing staff, paying forward the gift that she received.

Correction: May 20, 2012

A picture caption with Nicholas D. Kristof’s column last Sunday incorrectly described the Tanzanian woman shown. She had received spinal anesthesia in advance of an operation to repair a fistula; she was not in the process of getting the anesthetic.